The importance of transparency in the new healthcare marketplace

By | Uncategorized

Transparency in healthcare has been an important topic for many years. The usual focus of discussions in this area had been on providing the right information to leaders inside of the organization, to enable them to make good decisions about their businesses based upon the performance of various products, offerings and services teams. Being able to see these metrics in real-time, in a way that would enable these leaders to pivot or shift as market needs changed, was considered the key to any transparency initiatives. Over the past few years, the expectations related to organizational transparency have expanded significantly, particularly related to external transparency. This has been driven by a number of important factors, most significantly the shift away from traditional fee-for-service business models towards models that leverage new approaches including value-based benefits and value-based payments (also still sometimes call pay-for-performance). While internal transparency is still critical for business success, many health insurers are now realizing that external transparency is equally important. This is particularly true with regards to many of the new healthcare business models, and particularly those models that require the active participation of stakeholders like members and providers. The success of many of these new models will be gated by the health plans. ability to provide accurate, actionable, real-time information to everyone involved in the healthcare delivery cycle. Members must have the information required to enable them to quickly and accurately evaluate price, quality and service, and to comply with their recommended care plans. At the same time, providers must have the ability to get the real-time information that will be required for them to play their roles in the new healthcare ecosystem, particularly related to their care of at-risk groups who may be participating in new programs where the providers are rewarded for their ability to help drive a healthier and happier population. To be successful in this new marketplace, health plan executives must determine what will be required to fully participate in this evolving healthcare economy, and they must then build and then execute a plan to bring their organizations to the required levels of transparency in terms of their people, their business processes, and, most importantly, their technology.

 

By Ray Desrochers, Executive Vice President, HealthEdge

Change is the New Normal

By | Uncategorized
unnamed-2

Ray Desrochers, Chief Marketing Officer of HealthEdge

Regardless of who ends up in the White House after the current election cycle ends, it seems clear that health insurers will need to continue to address market change. New healthcare business models, including value-based benefits and payments, ACOs, Medicare and Medicaid expansion and the move towards public and private exchanges continue to stress the industry’s legacy technology infrastructure like never before. At the same time, consumers are demanding innovative new products and services, and access to information that is similar to what they have come to expect from every other industry. While there may be some debate as to which models will be most prominent during the next administration, one thing is clear: we won’t be returning to the one-size-fits-all healthcare models of yesterday.

Insurers are also increasingly focused on finding ways to manage and reduce their out-of-control administrative costs, and many are starting by taking a hard look at the technology that is driving their businesses. Many of these market leaders are consolidating their technology environments and eliminating the expensive, hard-to-maintain satellite systems and workarounds that have been negatively impacting their ability to operate high-performance organizations.
The result is many health insurers working to leverage modern technology to drive new levels of agility, efficiency and transparency, and to deliver the new options that their customers are demanding, all while driving down administrative costs.
Health plans that want to be successful in this new, consumer-centric healthcare marketplace must transform themselves, leveraging modern technology, to enable their organizations to rapidly address the changes that will continue to drive the market for the foreseeable future.
Ray Desrochers is Chief Marketing Officer at HealthEdge, provider of the only modern, enterprise-class software platform for health insurers. He is a frequent speaker at industry events and conferences around the world.